Prevalence and risk factors of fluid overload in Southern Chinese continuous ambulatory peritoneal dialysis patients

PLoS One. 2013;8(1):e53294. doi: 10.1371/journal.pone.0053294. Epub 2013 Jan 14.

Abstract

Background: Fluid overload is frequently present in CAPD patients and one of important predictors of mortality. The aim of this study is to investigate the prevalence and associated risk factors in a cohort study of Southern Chinese CAPD patients.

Methods: The patients (receiving CAPD 3 months and more) in our center were investigated from January 1, 2008 to December 31, 2009. Multi-frequency bioelectrical impedance analysis was used to assess the patient's body composition and fluid status.

Results: A total of 307 CAPD patients (43% male, mean age 47.8±15.3 years) were enrolled, with a median duration of PD 14.6 (5.9-30.9) months. Fluid overload (defined by Extracellular water/Total body water (ECW/TBW)≥0.40) was present in 205 (66.8%) patients. Univariate analysis indicated that ECW/TBW were inversely associated with body mass index (r = -0.11, P = 0.047), subjective global assessment score (r = -0.11, P = 0.004), body fat mass (r = -0.15, P = 0.05), serum albumin (r = -0.32, P<0.001), creatinine (r = -0.14, P = 0.02), potassium (r = -0.15, P = 0.02), and residual urine output (r = -0.14, P = 0.01), positively associated with age (r = 0.27, P<0.001), Chalrlson Comorbidity Index score (r = 0.29, P<0.001), and systolic blood pressure (r = 0.22, P<0.001). Multivariate linear regression showed that lower serum albumin (β = -0.223, P<0.001), lower body fat mass (β = -0.166, P = 0.033), old age (β = 0.268, P<0.001), higher systolic blood pressure (β = 0.16, P = 0.006), less residual urine output (β = -0.116, P = 0.042), and lower serum potassium (β = -0.126, P = 0.03) were independently associated with higher ECW/TBW. After 1 year of follow-up, the cardiac event rate was significantly higher in the patients with fluid overload (17.1% vs 6.9%, P = 0.023) than that of the normal hydrated patients.

Conclusions: The prevalence of fluid overload was high in CAPD patients. Fluid overload in CAPD patients were independently associated with protein-energy wasting, old age, and decreased residual urine output. Furthermore, CAPD patients with fluid overload had higher cardiac event rate than that of normal hydrated patents.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asian Continental Ancestry Group / statistics & numerical data*
  • Blood Pressure
  • Body Water
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / urine
  • China / epidemiology
  • Demography
  • Edema / etiology
  • Extracellular Space / metabolism
  • Female
  • Follow-Up Studies
  • Humans
  • Linear Models
  • Male
  • Malnutrition / etiology
  • Middle Aged
  • Multivariate Analysis
  • Peritoneal Dialysis, Continuous Ambulatory / adverse effects*
  • Peritoneal Dialysis, Continuous Ambulatory / statistics & numerical data*
  • Prevalence
  • ROC Curve
  • Risk Factors
  • Treatment Outcome
  • Water-Electrolyte Imbalance / epidemiology*
  • Water-Electrolyte Imbalance / etiology*
  • Water-Electrolyte Imbalance / physiopathology
  • Water-Electrolyte Imbalance / urine

Grant support

This work was supported by a grant from Key Project of Chinese Ministry of Health Clinical Disciplines ([2010]493). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.